Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Epstein, L.J.; Kristo, D.; Strollo, P.J., Jr.; Friedman, N.; Malhotra, A.; Patil, S.P.; Ramar, K.; Rogers, R.; Schwab, R.J.; Weaver, E.M.; et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep Med. 2009, 5, 263–276. [Google Scholar] [PubMed]
- Luo, K.; Zhang, L.; Zhang, X.; Han, T.; Li, Y.; Wang, C. Acceptance of and six-month adherence to continuous positive airway pressure in patients with moderate to severe obstructive sleep apnea. Clin. Respir. J. 2021, 15, 56–64. [Google Scholar] [CrossRef] [PubMed]
- Patil, S.P.; Ayappa, I.A.; Caples, S.M.; Kimoff, R.J.; Patel, S.R.; Harrod, C.G. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. J. Clin. Sleep Med. 2019, 15, 335–343. [Google Scholar] [CrossRef] [PubMed]
- Mehrtash, M.; Bakker, J.P.; Ayas, N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 2019, 197, 115–121. [Google Scholar] [CrossRef]
- Reeves-Hoche, M.K.; Meck, R.; Zwillich, C.W. Nasal CPAP: An objective evaluation of patient compliance. Am. J. Respir. Crit. Care Med. 1994, 149, 149–154. [Google Scholar] [CrossRef] [PubMed]
- Engleman, H.M.; Martin, S.E.; Douglas, N.J. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 1994, 49, 263–266. [Google Scholar] [CrossRef][Green Version]
- Kribbs, N.B.; Pack, A.I.; Kline, L.R.; Smith, P.L.; Schwartz, A.R.; Schubert, N.M.; Redline, S.; Henry, J.N.; Getsy, J.E.; Dinges, D.F. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am. Rev. Respir. Dis. 1993, 147, 887–895. [Google Scholar] [CrossRef]
- Sforza, E.; Bacon, W.; Weiss, T.; Thibault, A.; Petiau, C.; Krieger, J. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 2000, 161, 347–352. [Google Scholar] [CrossRef]
- Finkelstein, Y.; Wexler, D.; Horowitz, E.; Berger, G.; Nachmani, A.; Shapiro-Feinberg, M.; Ophir, D. Frontal and lateral cephalometry in patients with sleep-disordered breathing. Laryngoscope 2001, 111, 634–641. [Google Scholar] [CrossRef]
- Shigeta, Y.; Enciso, R.; Ogawa, T.; Shintaku, W.H.; Clark, G.T. Correlation between retroglossal airway size and body mass index in OSA and non-OSA patients using cone beam CT imaging. Sleep Breath. 2008, 12, 347–352. [Google Scholar] [CrossRef]
- Segal, Y.; Malhotra, A.; Pillar, G. Upper airway length may be associated with the severity of obstructive sleep apnea syndrome. Sleep Breath. 2008, 12, 311–316. [Google Scholar] [CrossRef] [PubMed]
- Kim, E.J.; Choi, J.H.; Kim, Y.S.; Kim, T.H.; Lee, S.H.; Lee, H.M.; Shin, C.; Lee, S.H. Upper airway changes in severe obstructive sleep apnea: Upper airway length and volumetric analyses using 3D MDCT. Acta Otolaryngol. 2011, 131, 527–532. [Google Scholar] [CrossRef] [PubMed]
- Friedman, M.; Ibrahim, H.; Bass, L. Clinical staging for sleep-disordered breathing. Otolaryngol. Head Neck Surg. 2002, 127, 13–21. [Google Scholar] [CrossRef] [PubMed]
- Johns, M.W. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991, 14, 540–545. [Google Scholar] [CrossRef]
- Cho, Y.W.; Lee, J.H.; Son, H.K.; Lee, S.H.; Shin, C.; Johns, M.W. The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath. 2011, 15, 377–384. [Google Scholar] [CrossRef]
- Han, E.-K.; Yoon, I.-Y.; Chung, S. The compliance and effect of CPAP in obstructive sleep apnea syndrome. Sleep Med. Psychophysiol. 2006, 13, 52–58. [Google Scholar]
- Choi, J.-B.; Lee, S.-H.; Jeong, D.-U. Compliance of nasal continuous positive airway pressure in patients with obstructive sleep apnea syndrome. Sleep Med. Psychophysiol. 2006, 13, 27–32. [Google Scholar]
- Kim, J.H.; Kwon, M.S.; Song, H.M.; Lee, B.J.; Jang, Y.J.; Chung, Y.S. Compliance with positive airway pressure treatment for obstructive sleep apnea. Clin. Exp. Otorhinolaryngol. 2009, 2, 90–96. [Google Scholar] [CrossRef]
- Rowland, S.; Aiyappan, V.; Hennessy, C.; Catcheside, P.; Chai-Coezter, C.L.; McEvoy, R.D.; Antic, N.A. Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea. J. Clin. Sleep Med. 2018, 14, 101–108. [Google Scholar] [CrossRef]
- Young, T.; Peppard, P.E.; Gottlieb, D.J. Epidemiology of obstructive sleep apnea: A population health perspective. Am. J. Respir. Crit. Care Med. 2002, 165, 1217–1239. [Google Scholar] [CrossRef]
- Gay, P.; Weaver, T.; Loube, D.; Iber, C. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006, 29, 381–401. [Google Scholar] [CrossRef] [PubMed]
- Campos-Rodriguez, F.; Martinez-Alonso, M.; Sanchez-de-la-Torre, M.; Barbe, F. Long-term adherence to continuous positive airway pressure therapy in non-sleepy sleep apnea patients. Sleep Med. 2016, 17, 1–6. [Google Scholar] [CrossRef] [PubMed]
- Kohler, M.; Smith, D.; Tippett, V.; Stradling, J.R. Predictors of long-term compliance with continuous positive airway pressure. Thorax 2010, 65, 829–832. [Google Scholar] [CrossRef] [PubMed]
- Krieger, J.; Kurtz, D.; Petiau, C.; Sforza, E.; Trautmann, D. Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep 1996, 19, S136–S143. [Google Scholar] [CrossRef]
- Kurt, G.; Sisman, C.; Akin, E.; Akcam, T. Cephalometric comparison of pharyngeal airway in snoring and non-snoring patients. Eur. J. Dent. 2011, 5, 84–88. [Google Scholar] [CrossRef][Green Version]
- Tsai, H.H.; Ho, C.Y.; Lee, P.L.; Tan, C.T. Cephalometric analysis of nonobese snorers either with or without obstructive sleep apnea syndrome. Angle Orthod. 2007, 77, 1054–1061. [Google Scholar] [CrossRef]
- Eun, Y.G.; Kim, S.W.; Kim, M.G.; Cho, J.S. Clinical Predictor in Obstructive Sleep Apnea Patient. Korean J. Otorhinolaryngol.-Head Neck Surg. 2006, 49, 616–622. [Google Scholar]
- Neelapu, B.C.; Kharbanda, O.P.; Sardana, H.K.; Balachandran, R.; Sardana, V.; Kapoor, P.; Gupta, A.; Vasamsetti, S. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med. Rev. 2017, 31, 79–90. [Google Scholar] [CrossRef]
- Susarla, S.M.; Abramson, Z.R.; Dodson, T.B.; Kaban, L.B. Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea. J. Oral Maxillofac. Surg. 2010, 68, 2846–2855. [Google Scholar] [CrossRef]
- Shigeta, Y.; Ogawa, T.; Tomoko, I.; Clark, G.T.; Enciso, R. Soft palate length and upper airway relationship in OSA and non-OSA subjects. Sleep Breath. 2010, 14, 353–358. [Google Scholar] [CrossRef]
- Peh, W.C.; Ip, M.S.; Chu, F.S.; Chung, K.F. Computed tomographic cephalometric analysis of Chinese patients with obstructive sleep apnoea. Australas. Radiol. 2000, 44, 417–423. [Google Scholar] [CrossRef]
- Kim, E.J.; Choi, J.H.; Kim, K.W.; Kim, T.H.; Lee, S.H.; Lee, H.M.; Shin, C.; Lee, K.Y.; Lee, S.H. The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis. Eur. Arch. Otorhinolaryngol. 2011, 268, 533–539. [Google Scholar] [CrossRef] [PubMed]
- Villaneuva, A.T.; Buchanan, P.R.; Yee, B.J.; Grunstein, R.R. Ethnicity and obstructive sleep apnoea. Sleep Med. Rev. 2005, 9, 419–436. [Google Scholar] [CrossRef] [PubMed]
- Schorr, F.; Kayamori, F.; Hirata, R.P.; Danzi-Soares, N.J.; Gebrim, E.M.; Moriya, H.T.; Malhotra, A.; Lorenzi-Filho, G.; Genta, P.R. Different Craniofacial Characteristics Predict Upper Airway Collapsibility in Japanese-Brazilian and White Men. Chest 2016, 149, 737–746. [Google Scholar] [CrossRef] [PubMed]
Adherent (N = 136) | Nonadherent (N = 49) | p-Value | ||
---|---|---|---|---|
Gender (male/female) | 126 (92.6)/10 (7.4) | 39 (79.6)/10 (20.4) | 0.012 | |
Age (years) | 49.4 ± 9.6 | 49.7 ± 11.4 | 0.852 | |
Height (cm) | 172.3 ± 6.6 | 169.4 ± 7.6 | 0.012 | |
Weight (kg) | 81.6 ± 13.2 | 79.1 ± 14.5 | 0.265 | |
BMI (kg/m2) | 27.4 ± 3.5 | 27.4 ± 3.8 | 0.947 | |
HTN | 60 (44.1) | 20 (41.7) | 0.768 | |
DM | 17 (12.5) | 5 (10.4) | 0.702 | |
PSQI | 8.4 ± 3.1 | 8.6 ± 3.0 | 0.777 | |
KESS | 9.6 ± 5.0 | 8.8 ± 3.8 | 0.275 | |
Friedman palatal position | 1 | 3 (2.2) | 1 (2.0) | 0.302 |
2 | 9 (6.6) | 4 (8.2) | ||
3 | 86 (63.2) | 35 (71.4) | ||
4 | 38 (27.9) | 9 (18.4) | ||
Tonsil size | 1 | 120 (88.2) | 41 (83.7) | 0.214 |
2 | 14 (10.3) | 6 (12.2) | ||
3 | 2 (1.5) | 1 (2.0) | ||
4 | 0 (0.0) | 1 (2.0) |
Adherent | Nonadherent | p-Value | |
---|---|---|---|
TST (minutes) | 338.5 ± 35.6 | 349.1 ± 32.9 | 0.072 |
Sleep efficiency (%) | 86.8 ± 11.2 | 85.3 ± 10.4 | 0.433 |
AHI (/hour) | 42.8 ± 23.8 | 27.8 ± 21.1 | <0.001 |
RDI (/hour) | 46.5 ± 23.2 | 32.6 ± 20.9 | <0.001 |
ODI (/hour) | 34.8 ± 23.9 | 23.5 ± 21.8 | 0.004 |
Limb movement (/hour) | 17.1 ± 18.9 | 16.7 ± 16.4 | 0.915 |
PLMS (/hour) | 9.0 ± 17.5 | 8.2 ± 15.0 | 0.762 |
REM (%) | 12.7 ± 4.8 | 12.6 ± 4.5 | 0.860 |
Wake (%) | 12.0 ± 11.0 | 13.2 ± 10.4 | 0.536 |
AI (/hour) | 44.5 ± 20.9 | 30.6 ± 18.0 | <0.001 |
REM AHI (/hour) | 43.2 ± 24.0 | 33.5 ± 24.9 | 0.018 |
Supine AHI (/hour) | 52.9 ± 24.4 | 38.7 ± 23.5 | 0.001 |
Nadir SpO2 (%) | 77.3 ± 9.5 | 81.7 ± 7.5 | 0.004 |
Usage time (hours) | 5.2 ± 1.0 | 2.3 ± 0.9 | <0.001 |
* 90% pressure (cmH2O) | 9.8 ± 2.2 | 8.7 ± 1.6 | <0.001 |
Adherent | Nonadherent | p-Value | |
---|---|---|---|
H-PNS (mm) | 79.2 ± 7.2 | 75.6 ± 8.2 | 0.004 |
PNS-MP (mm) | 50.8 ± 5.5 | 50.4 ± 6.0 | 0.697 |
H-MP (mm) | 21.0 ± 5.6 | 18.3 ± 6.1 | 0.005 |
sPAS (mm) | 9.1 ± 2.5 | 9.6 ± 2.7 | 0.300 |
iPAS (mm) | 11.2 ± 3.2 | 11.4 ± 3.5 | 0.704 |
SPL (mm) † | 39.9 ± 5.0 | 38.8 ± 4.0 | 0.189 |
AP (mm) † | 15.5 ± 4.3 | 15.4 ± 4.4 | 0.846 |
LW (mm) † | 24.6 ± 7.1 | 25.5 ± 6.3 | 0.459 |
SA (mm2) † | 382.3 ± 150.8 | 395.0 ± 155.8 | 0.638 |
AWA (mm2) † | 209.3 ± 94.1 | 222.2 ± 94.2 | 0.440 |
AWA/SA † | 0.55 ± 0.10 | 0.56 ± 0.06 | 0.446 |
Adherent | Nonadherent | p-Value | |
---|---|---|---|
H-PNS (mm) | 76.9 (7.9–78.9) | 74.9 (72.5–77.3) | 0.074 |
PNS-MP (mm) | 49.3 (47.7–50.9) | 49.7 (47.8–50.9) | 0.638 |
H-MP (mm) | 20.4 (18.7–22.0) | 18.2 (16.3–20.2) | 0.027 |
sPAS (mm) | 9.7 (8.9–10.4) | 10.0 (9.1–10.9) | 0.395 |
iPAS (mm) | 10.9 (9.9–11.9) | 11.4 (10.2–12.5) | 0.406 |
SPL (mm) † | 38.3 (36.8–39.8) | 37.8 (36.0–39.5) | 0.540 |
AP (mm) † | 15.0 (13.6–16.5) | 15.2 (13.5–16.8) | 0.879 |
LW (mm) † | 24.7 (22.4–27.0) | 25.9 (23.3–28.5) | 0.331 |
SA (mm2) † | 367.5 (317.7–417.2) | 392.7 (334.7–450.7) | 0.357 |
AWA (mm2) † | 198.0 (167.3–228.8) | 219.2 (183.4–255.1) | 0.211 |
AWA/SA † | 0.54 (0.51–0.57) | 0.55 (0.52–0.59) | 0.329 |
B | SE | p-Value | |
---|---|---|---|
H-PNS (mm) | 1.14 | 0.22 | <0.001 |
PNS-MP (mm) | 0.64 | 0.32 | 0.045 |
H-MP (mm) | 1.51 | 0.28 | <0.001 |
sPAS (mm) | −0.15 | 0.70 | 0.834 |
iPAS (mm) | 0.04 | 0.54 | 0.937 |
SPL (mm) | 0.01 | 0.01 | 0.189 |
AP (mm) | 1.07 | 0.45 | 0.018 |
LW (mm) | −0.57 | 0.28 | 0.044 |
SA (mm2) | 0.00 | 0.01 | 0.962 |
AWA (mm2) | −0.02 | 0.02 | 0.361 |
Adherence | AHI > 30 | ||||
---|---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | ||
H-PNS (mm) | <74.8 | 1 (reference) | 1 (reference) | ||
74.8–83.0 | 2.38 (1.07–5.28) | 0.033 | 1.92 (0.94–3.93) | 0.073 | |
>83.0 | 2.58 (1.14–5.81) | 0.022 | 4.86 (2.24–10.54) | <0.001 | |
PNS-MP (mm) | <48.5 | 1 (reference) | 1 (reference) | ||
48.5–52.7 | 0.74 (0.33–1.63) | 0.454 | 0.85 (0.42–1.72) | 0.651 | |
>52.7 | 0.96 (0.42–2.18) | 0.918 | 1.42 (0.69–2.94) | 0.341 | |
H-MP (mm) | <17.5 | 1 (reference) | 1 (reference) | ||
17.5–22.8 | 1.62 (0.75–3.48) | 0.219 | 1.68 (0.82–3.41) | 0.154 | |
>22.8 | 2.93 (1.25–6.86) | 0.013 | 4.00 (1.87–8.56) | <0.001 | |
sPAS (mm) | <8.1 | 1 (reference) | 1 (reference) | ||
8.1–10.3 | 1.97 (0.79–4.87) | 0.144 | 1.31 (0.64–2.68) | 0.452 | |
>10.3 | 0.52 (0.24–1.13) | 0.099 | 1.01 (0.50–2.04) | 0.988 | |
iPAS (mm) | <9.8 | 1 (reference) | 1 (reference) | ||
9.8–12.8 | 0.77 (0.34–1.75) | 0.534 | 0.72 (0.35–1.47) | 0.365 | |
>12.8 | 0.70 (0.31–1.57) | 0.382 | 0.74 (0.36–1.53) | 0.420 | |
SPL (mm) | <37.4 | 1 (reference) | 1 (reference) | ||
37.4–41.1 | 0.92 (0.41–2.06) | 0.837 | 1.25 (0.59–2.67) | 0.562 | |
<41.1 | 2.25 (0.90–5.63) | 0.084 | 1.41 (0.66–3.05) | 0.375 | |
AP (mm) | <13.0 | 1 (reference) | 1 (reference) | ||
13.0–16.6 | 1.71 (0.73–4.02) | 0.221 | 0.96 (0.44–2.06) | 0.910 | |
>16.6 | 1.39 (0.61–3.20) | 0.435 | 0.79 (0.37–1.71) | 0.558 | |
LW (mm) | <21.5 | 1 (reference) | 1 (reference) | ||
21.5–27.5 | 1.12 (0.47–2.67) | 0.789 | 0.49 (0.22–1.06) | 0.071 | |
>27.5 | 0.87 (0.38–2.00) | 0.738 | 0.51 (0.23–1.10) | 0.086 | |
SA (mm2) | <303.5 | 1 (reference) | 1 (reference) | ||
303.5-433.0 | 1.81 (0.73–4.46) | 0.197 | 0.83 (0.39–1.79) | 0.635 | |
>433.0 | 0.82 (0.36–1.85) | 0.631 | 0.83 (0.39–1.79) | 0.635 | |
AWA (mm2) | <164.2 | 1 (reference) | 1 (reference) | ||
164.2–237.0 | 1.00 (0.42–2.36) | >0.999 | 0.46 (0.21–1.01) | 0.053 | |
>237.0 | 0.79 (0.34–1.84) | 0.580 | 0.58 (0.27–1.28) | 0.179 |
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Park, J.-S.; Kwon, B.; Kang, H.-S.; Yun, S.-J.; Han, S.-J.; Choi, Y.; Kang, S.-H.; Lee, M.-Y.; Lee, K.-C.; Hong, S.-J. Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence. J. Pers. Med. 2023, 13, 1196. https://doi.org/10.3390/jpm13081196
Park J-S, Kwon B, Kang H-S, Yun S-J, Han S-J, Choi Y, Kang S-H, Lee M-Y, Lee K-C, Hong S-J. Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence. Journal of Personalized Medicine. 2023; 13(8):1196. https://doi.org/10.3390/jpm13081196
Chicago/Turabian StylePark, Jae-Seon, Bin Kwon, Hyun-Seok Kang, Seong-Jin Yun, Sung-Jun Han, Yeso Choi, Sung-Hun Kang, Mi-Yeon Lee, Kyung-Chul Lee, and Seok-Jin Hong. 2023. "Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence" Journal of Personalized Medicine 13, no. 8: 1196. https://doi.org/10.3390/jpm13081196
APA StylePark, J.-S., Kwon, B., Kang, H.-S., Yun, S.-J., Han, S.-J., Choi, Y., Kang, S.-H., Lee, M.-Y., Lee, K.-C., & Hong, S.-J. (2023). Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence. Journal of Personalized Medicine, 13(8), 1196. https://doi.org/10.3390/jpm13081196